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Doctor's Column

VEC And Vascular Education

Complex open vascular surgery skills and experience are becoming a lost art in Singapore having been replaced by endovascular solutions as first line treatment for...
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Home|Popliteal Entrapment And Chronic Compartment Syndromes

Popliteal Entrapment And Chronic Compartment Syndromes

Popliteal entrapment syndrome

Popliteal entrapment syndrome is a rare condition in which the popliteal artery, which supplies blood to the lower leg and foot, is compressed or squeezed by nearby structures, such as the muscles and tendons at the back of the knee. This can cause reduced blood flow to the lower leg and foot, leading to pain, numbness, weakness, and other symptoms. It is most commonly seen in young athletes and can be treated with surgery or other interventions aimed at relieving the compression of the artery.

Popliteal entrapment syndrome can be diagnosed through a combination of clinical evaluation, imaging studies, and vascular testing. The diagnosis is typically made by a vascular surgeon or a specialist in vascular medicine.

During the clinical evaluation, the doctor will ask about the patient’s symptoms and medical history and perform a physical examination, looking for signs of reduced blood flow to the lower leg and foot, such as pulselessness, coldness, or discolouration.

Imaging studies, such as ultrasound, CT scan, or MRI, can help visualize the anatomy of the popliteal artery and nearby structures, such as muscles and tendons, and identify any areas of compression or stenosis.

Vascular testing, such as ankle-brachial index (ABI) or Doppler ultrasound, can measure blood pressure and blood flow in the affected leg and help determine the severity of the condition.

In some cases, a treadmill test may be performed to simulate exercise and provoke symptoms, which can help diagnose popliteal entrapment syndrome.

The treatment of popliteal entrapment syndrome depends on the severity of symptoms and the degree of arterial compression. Conservative measures may include rest, physical therapy, and anti-inflammatory medication. However, in severe cases, surgical intervention may be necessary.

Surgical treatment may involve one of several procedures, including the following:

  • 1. Release of the popliteal artery: This involves detaching the muscle responsible for compressing the artery and creating a new path for the artery.
  • 2. Arterial bypass grafting: This involves creating a new path for blood flow around the compressed artery using a graft.
  • 3. Endovascular stenting: This involves inserting a metal mesh tube (stent) into the artery to hold it open.

The choice of treatment depends on the specific factors of the patient’s case, including the degree of compression, the location of the obstruction, and the presence of associated complications.

Chronic compartment syndrome is a condition characterized by increased pressure within a muscle compartment, leading to pain, numbness, and weakness. It typically affects the legs, but can also occur in the arms, hands, and feet.

The condition occurs when the fascia, a tough membrane that surrounds muscle groups, becomes too tight or thick, causing compression of the muscles and nerves within the compartment. This can occur due to overuse, repetitive motions, or trauma.

Symptoms of chronic compartment syndrome include:

  • Pain or cramping during exercise that resolves with rest
  • Numbness or tingling in the affected area
  • Weakness or difficulty using the affected muscles
  • Swelling or tightness in the affected area
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Treatment for chronic compartment syndrome may include:

  • Rest and avoid activities that aggravate symptoms
  • Physical therapy to stretch and strengthen muscles
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) to relieve pain and inflammation
  • Surgery to release the fascia and relieve pressure on the affected muscles and nerves

It is important to see a vascular specialist for an accurate diagnosis and appropriate treatment plan. If left untreated, chronic compartment syndrome can lead to permanent muscle and nerve damage.

Treatment chronic compartment

Pre-release in neutral position

Treatment chronic compartment2

Left foot in plantarflexion showing popliteal artery blood flow cut off from entrapment of the surrounding tissue

Treatment chronic compartment3

Post popliteal artery dissection to remove impinging tissue with foot again in plantarflexion showing blood flow not impaired by the surrounding tissue.

chronic compartment syndrome
chronic compartment syndrome2
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Fibroids shrinkage after UFE

Varicose veins screening package (single leg)

  • Consultation & Review – assess history, risk factors, life style, symptoms
  • Examination – to check distribution and anatomy plus to assess skin problem
  • Ultrasound reflux scan – to check for venous insufficiency (two legs add $450 + GST)
  • $588 + GST

Spider veins screening package (single leg)

  • Consultation & Review – assess history, risk factors, life style, symptoms
  • Examination – to check distribution and anatomy plus to assess skin problem
  • 1 session laser treatment – (additional session $450 + GST)
  • $588 + GST

Varicose veins and spider veins package (single leg)

  • Consultation & Review – assess history, risk factors, life style, symptoms
  • Examination – to check distribution and anatomy plus to assess skin problem
  • Ultrasound reflux scan – to check for venous insufficiency (two legs add $450 + GST)
  • 1 session spider vein laser treatment (additional session 450 + GST)
  • $988 + GST (two legs – add $400 + GST)

Diabetic foot screening (basic)

  • Consultation & Review – assess history, risk factors, life style, symptoms
  • Examination – to check circulation, biomechanics of foot arch, sensory loss
  • Ankle brachial pressure index (lab) – to check blood flow in legs
  • Blood test – to check average sugar levels in 3 months
  • $388 + GST

Diabetic foot screening (extensive)

  • Consultation & Review – assess history, risk factors, life style, symptoms
  • Examination – to check circulation, biomechanics of foot arch, sensory loss
  • Ankle brachial pressure index (lab) – to check blood flow in legs
  • Blood test – to check average sugar levels in 3 months
  • Single leg arterial duplex – to identify specific artery problem (additional leg scan $400 + GST)
  • X-ray one foot – to check bone infection
  • $888 + GST

Cardiovascular screening (normal)

  • Consultation & Review – assess history, risk factors, life style, symptoms
  • Examination – full cardiovascular examination including the heart and limb arteries
  • Ankle brachial pressure index (lab) – this is a marker for longevity and cardiovascular health
  • Blood tests (lipids) – to check all the types of cholesterol
  • Carotid scan – to identify block artery to the brain hence stroke
  • Echocardiogram – to identify heart muscle function
  • $1098 + GST

Cardiovascular screening (comprehensive)

  • Consultation & Review – assess history, risk factors, life style, symptoms
  • Examination – full cardiovascular examination including the heart and limb arteries
  • Ankle brachial pressure index (lab) – this is a marker for longevity and cardiovascular health
  • Blood tests (lipids) – to check all the types of cholesterol
  • Carotid scan – to identify block artery to the brain hence stroke
  • CT coronary Angiogram plus calcium score – gold standard to identify block heart arteries
  • $2098 + GST

Our Doctors

Dr Julian Wong

Dr Julian Wong

Senior Vascular & General Surgeon
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Dr Tang Tjun Yip

Dr Tang Tjun Yip

Senior Vascular & General Surgeon
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Conditions We Treat